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目的分析心肌淀粉样变及肥厚型心肌病患者心电图参数,获得能够简易快捷地诊断心肌淀粉样变及与肥厚型心肌病相鉴别的诊断流程。方法心肌淀粉样变患者(A组)、肥厚型心肌病患者(C组)、正常对照(B组)各30例,比较心电图参数特征,通过ROC曲线及logistic回归分析心电图参数的诊断价值并提出诊断流程。结果 A组肢体导联及左胸导联(V5、V6)低电压、假性梗死波及胸前导联R波递增不良比例较B组增高。诊断心肌淀粉样变(与B组鉴别):a VR导联QRS振幅(QRSa VR)联合PR间期减去P波时限(PR-P时限):敏感性96.30%,特异性96.67%,正确率96.49%。鉴别心肌淀粉样变与肥厚型心肌病:I导联QRS振幅(QRSI):界值0.46m V,敏感性90.00%,特异性96.67%;QRSa VR:界值0.41m V,敏感性93.33%,特异性93.33%;所有肢体导联QRS电压之和(6∑QRS):界值2.71m V,敏感性96.67%,特异性83.33%。结论心肌淀粉样变心电图多出现肢体导联及左胸导联低电压,假性梗死波,胸前导联R波递增不良等表现。QRSa VR联合PR-P时限可用于筛查心肌淀粉样变。QRSI、QRSa VR、6∑QRS可用于鉴别心肌淀粉样变和肥厚型心肌病。
Objective To analyze the parameters of electrocardiogram in patients with myocardial amyloidosis and hypertrophic cardiomyopathy and to obtain a diagnostic procedure that can diagnose myocardial amyloidosis easily and quickly and differentiate it from hypertrophic cardiomyopathy. Methods Thirty patients with myocardial amyloidosis (group A), hypertrophic cardiomyopathy (group C) and 30 normal controls (group B) were enrolled. The electrocardiogram parameters were compared. The diagnostic value of electrocardiogram parameters was analyzed by ROC curve and logistic regression Diagnostic process. Results Low voltage and false infarction in lead and left chest leads (V5, V6) in group A were higher than those in group B in R wave increase. Diagnosis of myocardial amyloidosis (with group B): a VR lead QRS amplitude (QRSa VR) combined with PR interval minus the P wave time limit (PR-P time limit): sensitivity 96.30%, specificity 96.67%, the correct rate 96.49%. Identification of myocardial amyloidosis and hypertrophic cardiomyopathy: I lead QRS amplitude (QRSI): cutoff 0.46m V, sensitivity 90.00%, specificity 96.67%; QRSa VR: cutoff 0.41m V, the sensitivity of 93.33% Specificity 93.33%. The sum of QRS voltage of all limb leads (6ΣQRS): the cutoff value was 2.71mV, the sensitivity was 96.67% and the specificity was 83.33%. Conclusion Myocardial amyloidosis electrocardiogram often appear in limb lead and left chest lead low voltage, false infarction wave, thoracic precordial R wave increased poor performance. QRSa VR combined with PR-P time limit can be used to screen for myocardial amyloidosis. QRSI, QRSa VR, 6ΣQRS can be used to identify myocardial amyloidosis and hypertrophic cardiomyopathy.